1
Navigating Our Way to a Digital Experience
Session #251, February 14, 2019
Jennifer Theriault, Director of Strategic Initiatives, Brigham Health
Steve Penney, Mobile Specialist, Brigham Health
2
Jennifer Theriault, MSHI
Steve Penney, MBA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Where to start: Push-pull of operations and
innovation at an AMC
• How to get there: Defining the gap and creating
path to sustainability
• Seeking a Destination: Examples
– Wayfinding
– IoT
– Virtual Voice Assistants
• Find your path: Practical takeaways for your
institution
Agenda
4
• Identify technology advances that enable success
at AMC's and challenge our industry colleagues
to translate commercial expectations to an
enterprise environment.
• Develop a framework for evaluating new
technology across a multi-site hospital system.
• Demonstrate tools for vendors and
implementation team that enable successful
pilots of new technologies across a complex
multi-site hospital system.
Learning Objectives
5
Our commitment is not limited to one point on a map. Brigham
Health is a global health leader committed to creating a healthier
world.
• Reaching out—locally, nationally, and internationally.
• Bringing information and expertise to maintaining and restoring
health.
• Being part of daily life and helping people make the best
decisions about their health, even if they never set foot inside our
walls.
About Brigham Health
Our patients come from over 120 countries.
· 8,000 babies born
· 61,000 emergency room visits
· 3.9 million outpatient encounters
· 777 inpatient beds
· 47 operating rooms
· 150 ambulatory practices
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Applications were not
scalable nor interoperable.
PAST:
HOMEGROWN SYSTEMS
Partners has heavily
invested in Epic, an
enterprise solution to
streamline health data
management.
PRESENT:
EPIC FOUNDATION
New technologies and delivery
models will leverage the foundation to
disrupt the status quo to accelerate
improvement of health and the
delivery of care.
We should be the partner of choice
for innovators across the digital health
landscape.
FUTURE: NEW
TECHNOLOGY
ADOPTION
Where we’re Headed
7
• Where to start: Push-pull of operations and
innovation at an AMC
• How to get there: Defining the gap and creating
path to sustainability
• Seeking a Destination: Examples
– Wayfinding
– IoT
– Virtual Voice Assistants
• Find your path: Practical takeaways for your
institution
Agenda
8
IS Operations- Structure & Planning
Enterprise IS: Partners Healthcare
Centralized Core Functions
Desktop/Service Desk
Data Center
Telcom
Network Engineering
Application Delivery
Access/Email
Endpoint Computing
Research IT
Enterprise Applications
Enterprise IS: Partners Healthcare
Centralized Core Functions
Desktop/Service Desk
Data Center
Telcom
Network Engineering
Application Delivery
Access/Email
Endpoint Computing
Research IT
Enterprise Applications
Entity IS: Brigham Health
Partner with Enterprise on:
Customer Service
Upgrades & Support
EMR Optimization
New Systems
Network Expansion & Real Estate
Information Security
Mobile Technology/Communications
Site prioritization/Governance
Entity IS: Brigham Health
Partner with Enterprise on:
Customer Service
Upgrades & Support
EMR Optimization
New Systems
Network Expansion & Real Estate
Information Security
Mobile Technology/Communications
Site prioritization/Governance
9
IS Operations: Structure & Planning (ITPAC)
Defined multi-layered governance
Established prioritization process
Tight fiscal planning, much of the
resource capacity is consumed by non-
discretionary, must do projects
10
11
Digital Health Innovation at BWH
12
The DHIG governance committee and process reduces risk for both individual
projects and for the broader organization, improving the likelihood success by
ensuring proper approvals and best practices are followed.
COPYRIGHT NOTIC E
Brigham & Women ’s Hospital. Rights Re served. This work is distributed under th e Creative Commons Attribution-NonComm ercial-ShareAlike 4.0
License (“License ”), which permits unr estricted sharing of th is work, provided tha t: (1) it may not be u sed for commercial p urposes; (2) Adapted
Material may be pre pared and shall be m ade freely available u nder identical terms and conditions of the License; and (3) attri bution must be given
to Brigham & Wom en’s Hospital.
All terms and cond itions of the License ar e available here:
https://creativecom mons.org/licenses/ by-nc-sa/4.0/legalcode
*Listed assets m ay be available up on request. Plea se contact us at b whihub.org or em ail ihub@partners.org for more inf ormation.
Rev 1.4 – May 15, 2 017
Digital Health Innovation Guide (DHIG) Checklist
Requirement
Description
Assets
Contracting & Legal
Business Associate Agreement
(BAA)
Agreement between the vendor and
subcontractors who will be performing a
service on behalf of the institution and will
have access to patient health information
(protected health information or “PHI”).
Brigham and Women’s Hospital
(BWH) standard BAA template*
Statement of W ork (SOW)
Agreement between innovator and vendor
as to pilot scope. Used for contracting
purposes and must be signed off by supply
chain for a PO to be issued. Substantial
modifications or enhancements to develop
should consider a new SOW.
Partners HealthCare System
(PHS) standard SOW template*
Support for Product During
Pilot
It is the application owner's responsibility
to provide application support for all users.
Discuss with your client how you will
manage issues and turnaround time.
Terms and Conditions (T&C)
Review
T&C for patients and other users must be
approved by client's legal.
Sample T&C document*
Marketing
& Public
Affairs
Reference Hospital in
Marketing/PR
Approval for any planned project PR must
be discussed with hospital in advance.
There can be limits on how to incorporate
hospital in marketing/PR.
Publishing
Results
Research or Quality
Improvement (QI) Submission
Pilots need to determine if an IRB review is
required for research purposes or if the
proposed activity is clinical quality
improvement/measurement, in which case
IRB review is not required. If a pilot is
research, then the IRB approval must be
complete prior to launch. This should also
be included in the SOW.
Clinical Quality Improvement
checklist*
Security
Security Risk Assessment
Security review of the app to ensure that it
will be safe within hospital environment.
This is also where HIPAA compliance is
addressed.
BWH IS standard vendor
cybersecurity risk assessment
form*
Security Scans
A subcomponent of the risk assessment:
May include Veracode and Qualys scans,
depending on product design.
CHECKLIST-DRIVEN PROCESS
Pre-approved/customizable guardrails and
regular check-ins keep projects on track
CROSS-FUNCTIONAL GUIDANCE
Information Security, Partners eCare,
Compliance, IRB, Partners Innovation and
other teams
PROJECTS REVIEWED
100+
AVERAGE TIME FROM INTAKE TO
PILOT
FOR PROJECTS WHICH
ULTIMATELY EXECUTED A PILOT
9
MONTHS
IMPACT TO DATE
Digital Health Innovation Guide (DHIG)
13
Expedited Pathway to Launch
Tseng, Jocelyn, et. al. “Catalyzing Healthcare Transformation with Digital Health: Performance Indicators and
Lessons Learned from a Digital Health Innovation Group.” Healthcare, 25 Sept. 2017.
Sustainable Operations
14
• Where to start: Push-pull of operations and
innovation at an AMC
• How to get there: Defining the gap and creating
path to sustainability
• Seeking a Destination: Examples
– Wayfinding
– IoT
– Virtual Voice Assistants
• Find your path: Practical takeaways for your
institution
Agenda
15
Bridging the Gap
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Brigham Health has all the elements needed to scale innovation from pilot
to sustainable operations
Investors
Industry partners
Digital health start-ups
Academic collaborators
INNOVATION
ECOSYSTEM
Support Infrastructure
Scalable Resources
Expert IT Staff
Rich, proprietary data
BRIGHAM
HEALTH IS
TPASS
Keystone to Sustainability
Translate Planning and
Assessment to Scale
and Support
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Ensuring the relevant teams are aware and
the gotcha questions are asked and answered
TPASS Checklist
COPYRIGHT NOTIC E
Brigham & Women ’s Hospital. Rights Re served. This work is distributed under th e Creative Commons Attribution-NonComm ercial-ShareAlike 4.0
License (“License ”), which permits unr estricted sharing of th is work, provided tha t: (1) it may not be u sed for commercial p urposes; (2) Adapted
Material may be pre pared and shall be m ade freely available u nder identical terms and conditions of the License; and (3) attri bution must be given
to Brigham & Wom en’s Hospital.
All terms and cond itions of the License ar e available here:
https://creativecom mons.org/licenses/ by-nc-sa/4.0/legalcode
*Listed assets m ay be available up on request. Plea se contact us at b whihub.org or em ail ihub@partners.org for more inf ormation.
Rev 1.4 – May 15, 2 017
Digital Health Innovation Guide (DHIG) Checklist
Requirement
Description
Assets
Contracting & Legal
Business Associate Agreement
(BAA)
Agreement between the vendor and
subcontractors who will be performing a
service on behalf of the institution and will
have access to patient health information
(protected health information or “PHI”).
Brigham and Women’s Hospital
(BWH) standard BAA template*
Statement of W ork (SOW)
Agreement between innovator and vendor
as to pilot scope. Used for contracting
purposes and must be signed off by supply
chain for a PO to be issued. Substantial
modifications or enhancements to develop
should consider a new SOW.
Partners HealthCare System
(PHS) standard SOW template*
Support for Product During
Pilot
It is the application owner's responsibility
to provide application support for all users.
Discuss with your client how you will
manage issues and turnaround time.
Terms and Conditions (T&C)
Review
T&C for patients and other users must be
approved by client's legal.
Sample T&C document*
Marketing
& Public
Affairs
Reference Hospital in
Marketing/PR
Approval for any planned project PR must
be discussed with hospital in advance.
There can be limits on how to incorporate
hospital in marketing/PR.
Publishing
Results
Research or Quality
Improvement (QI) Submission
Pilots need to determine if an IRB review is
required for research purposes or if the
proposed activity is clinical quality
improvement/measurement, in which case
IRB review is not required. If a pilot is
research, then the IRB approval must be
complete prior to launch. This should also
be included in the SOW.
Clinical Quality Improvement
checklist*
Security
Security Risk Assessment
Security review of the app to ensure that it
will be safe within hospital environment.
This is also where HIPAA compliance is
addressed.
BWH IS standard vendor
cybersecurity risk assessment
form*
Security Scans
A subcomponent of the risk assessment:
May include Veracode and Qualys scans,
depending on product design.
• Pilot Information, history
• Operational Scope
• Product Information
• Product Use
• Roles & Responsibilities
• Documentation Checklist
• System Architecture
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Pathway to Sustainable Operations
INNOVATION COORDINATION OPERATION
DHIG
• Early
Stage
• Ideation
• Pilot
TPASS
ITPAC
• Handoff
• Assessment
• Planning
• Support
• Scale
• Manage
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Stepwise Process
Operations Pipeline. IT PAC follow ups are completed and project moves forward as
capacity allows or is requested to do further analysis and come back to IT PAC
Present at IT PAC: 1. Scope (pilot to ops or expanded implementation 2. Implementation
Resources 3. Support Resources 4. Timelines 5. Governance Group/Oversight
Complete the project specific TPASS checklist of items that need to be done prior to
assessment at IT PAC (visp, analysis, scope documents, etc.)
Schedule a post pilot touch base meeting with iHub rep, IS rep, and vendor. Purpose is
to connect the group and review what needs to be done prior to IT PAC
Identify pilots early in DHIG process that have a goal of moving to operations at BHIS
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1-2 clinics
Advancing
ideas
2-3 Departments
Integrating novel w/
existing
System-wide
Stable tech
The Combined Landscape
Innovation
Bleeding
Edge
Settled
Scale
Researcher/
Clinic
Hospital-wide
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• Where to start: Push-pull of operations and
innovation at an AMC
• How to get there: Defining the gap and creating
path to sustainability
• Seeking a Destination: Examples
– Wayfinding
– IoT
– Virtual Voice Assistants
• Find your path: Practical takeaways for your
institution
Agenda
22
Wayfinding
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Why: Desire to improve the
experience and ease of access
for all of our patients, families,
and staff.
How: Implement a multimodal
digital solution that complements
BWHC‘s physical wayfinding
ecosystem.
Why now: Wayfinding technology
and digital adoption has reached
a tipping point.
Wayfinding Background
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Sample Use Cases for Patients and
Families
Plan a Visit
Launch app or website enter home
address as start enter clinic location
Get Around Campus
Kiosk “knows” start
location search for
nearest restroom
Info Desk staff enters into
website a destination
based on patient
description print, e-mail
or text instructions
25
Faulkner Hospital is a Great Testbed
May 2017May 2017
Dec 2018Dec 2018 Spring 2019Spring 2019
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Crawl/Walk/Run Approach for Wayfinding
Mobile
Responsive Web
• Provide turn-by-turn
directions of public and
staff areas
• Maps of all locations
• Limited integration
• Develop consistent
icons, language for
maps
• Understand use cases
• Real-time indoor
positioning at
community hospital.
• Technology
development
• Further integration
with IS operations
teams to enable app
• Full scale
implementation
• Transition all support
and management to
IS Operations team
• Integrate SDK with
other apps
Crawl
Walk
Run
Bluedot
Community
hospital
Bluedot AMC
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Impact
Get More Value from
Existing Resources
Empower Patients &
Staff
Provide high value
tools & put Brigham
resources at their
fingertips so they can
navigate their
experience
seamlessly
Building Blocks
Layered approach
allowed quick launch
and absorption of
lessons learned that
builds upon itself
Identification of
additional programs
to integrate and
individuals’ expertise
to support program
goals enabled faster
adoption without re-
inventing the wheel
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Where do we go next
Add-Ons
Location-based
functionality such as
cafeteria coupons,
patient surveys,
public tours, asset
tracking and
additional apps
developed for BWH
Blue Dot
Indoor navigation
native to iOS and
Android mobile
devices. (Google
maps for inside the
hospital)
Multilingual
Support for written
translations native to
the kiosks and mobile
application
Patient Gateway
Integration with
appointment
reminders through
Patient Gateway and
text message
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IoT Buttons
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IoT Buttons @ Brigham Health
● Bluetooth or WiFi connected
● Battery life > 2,000 clicks
● Relatively cheap
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A major factor in poor Press Ganey scores for
hospitals is the cleanliness of public restrooms
A Common Hospital Problem
• Staff are not always the first ones to see the need for service.
• Method/Instructions for a visitor/patient to report a service need
are not clear or easy to do.
• Health and safety risks can arise.
• Major work flow changes to environmental and facilities groups is
a complicated and lengthy process.
• Opportunity to think innovatively for a solution to
a not-so-simple need.
• Consider and expand upon the existing
communication processes for this type of request
and action.
32
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IoT Buttons @ Brigham Health
● BWH Dash Bathroom Use Case
● Programmable for up to 3 functions
○ Single Click: dirty restroom email and SMS sent
○ Double Click: restroom cleaned email and SMS sent
○ Long Click: restroom inspected
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Four Month Usage Results
● Oct 2017 - Feb 2018
○ 1,356 total events logged
○ 907 single click requests
○ 382 double click requests
○ 67 long presses
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Crawl/Walk/Run Approach for IoT Innovation
Low Risk
• Non-urgent
• Non-clinical
• Not critical to operations
• Zero to Low HIPAA
exposure risk.
• “Nice to Have”
• Scale “Crawl” projects
• Low risk clinical use
cases
• Integrated to day to
day operations in a
meaningful way
• “We use this”
• Scale “Walk” projects
• Sustain existing
“Walk” projects
• “We rely on this”
Crawl
Walk
Run
In production
Scale
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Lessons Learned to get to Sustainable Operations
• Theft/Physical damage risk.
• Reprogrammable.
• Current buttons cannot connect to
certain secure WiFi configurations.
• Guest WiFi not meant for business
purposes and provided at best effort
basis which could lead to message
failure/delays.
• Look to expand and integrate
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Virtual Voice Assistants
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What gives you anxiety about virtual voice
assistants (Alexa, Google Home, etc) in a
healthcare setting?
Audience Poll:
-Hack/Vulnerability Risk
-It’s always listening
-User frustration/incorrect responses
-All of the above
38
• Organizational stance on Voice Virtual Assistants:
NOT TO BE USED
• Physical and Network Connectivity concerns
• Echo devices/Alexa service is not HIPPA Compliant
• Data and liability concerns
• As of Jan 2019, more than 100 million devices with
Amazon’s Alexa assistant pre-installed have been sold.
1
• >900,000 smart speakers will be used in healthcare
facilities in 2021.
2
• Voice-based Virtual Assistance is a rapidly growing space that
WILL impact patients and care givers.
Shhh…No Talking!
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• With technologies such as secure text messaging and similar
communication tools, the organization was slow to adopt and now
is playing catch up.
• Engaging Voice Assistants early provides an opportunity to
actively learn about the technology and align future projects.
• Placing Voice Assistants work under the umbrella of innovation,
and understanding the organization’s policies allows for us to
strategically engage and begin to progress this powerful
technology.
• To advance, this would require involving and aligning key IS
resources from multiple groups and concentrations.
How can we move forward?
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Innovate Together
Succeed Together
Innovation Group
• Initial concept support and
engagement.
• Bridge to entity (committees,
governance groups, etc.)
• Leverage vendor
relationships for mutual
advancement.
Information Security
• Engage immediately
• Ensure a mutual
understanding of the
innovation and IT boundaries.
• Keep a constant contact
cadence
IS Ops and PM
Groups
• Leverage existing project data
and support workflows.
• Manage costs and resources.
• Look for opportunities to
strengthen existing initiatives
• Provide learning and
feedback opportunities.
“When something is important
enough, you do it even if the
odds are not in your favor.”
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Crawl/Walk/Run Approach for Voice Innovation
General
Information
• General entity
information only.
• Visitor type agnostic.
• No clinical information
or advice.
• No identifying session or
user information saved.
• Zero to Low HIPAA
exposure risk.
• Patient-oriented
information.
• Could contain HIPAA or
PII information.
• Could contain clinical
information or advice.
• Access to the patient
EMR.
• Clinical Systems
Integrations.
• High potential HIPAA
exposure risk.
Crawl
Walk
Run
Non-EMR Patient
Information
EMR
Interfacing
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Voice Assistant Entry Point
The Faulkner Voice Assistant is a voice based, in-hospital
information guide which provides a new and interactive
experience for Faulkner Hospital patients and visitors.
“How do I get to the Spine Center?”
“What’s on the café menu?”
“When is the next shuttle arriving?”
“Where can I get a coffee?”
“Where is a bathroom?”
• Lives on a Guest WiFi Network
• Uses familiar hardware devices
• No session information is saved
• Leveraged existing Wayfinding data
• Strategically located and clear signage
• New central device management
• Customized alerting and alarming
• Onsite IS support during pilot
• Usage reports and activity frequency
• Compliments Patient Experience
Initiative
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• Where to start: Push-pull of operations and
innovation at an AMC
• How to get there: Defining the gap and creating
path to sustainability
• Seeking a Destination: Examples
– Wayfinding
– IoT
– Virtual Voice Assistants
• Find your path: Practical takeaways for your
institution
Agenda
44
Building Blocks of Innovation
Use them to design an engine
of innovation
Have a vision of your
destination
Processes and
components
already exist
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Keys to Success & Considerations
Engage Teams Early and Often
Find opportunities within the interconnectedness of your
organization. Work across silos to leverage knowledge,
process and user reach.
“Test and Learn”
Recognize that processes change and stakeholders will
impact requirements. Iterate, iterate, iterate. Ask why not.
Create Force Multipliers
Develop tools that enable non-traditional PMs to support
their own projects
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Let us know what you thought about our presentation by filling
out the online Session Evaluation!
Thank you for attending!
Questions
Josie Elias
Brigham iHub
Program Manager
JELIAS2@partners.org
Mark Zhang
Brigham iHub
Medical Director
HZHANG37@mgh.harvard.edu
Jenni Theriault
Brigham IS
Dir. of Strategic Initiatives
JATHERIAULT@partners.org
Steve Penney
Brigham IS
Mobile Specialist
SPENNEY@partners.org
47
1. Matney, L. (1/7/2019). More than 100 million Alexa devices have been sold. Retrieved from
https://techcrunch.com/2019/01/04/more-than-100-million-alexa-devices-have-been-sold/
2. Montany, B. (4/26/2018). More than 900,000 smart speakers to be used in healthcare facilities by 2021.
Retrieved from https://technology.ihs.com/602327/more-than-900000-smart-speakers-to-be-used-in-
healthcare-facilities-by-2021
Appendix and References